Opinion: The state's incompetence in managing Medicaid

Thursday

July 1 was supposed to be the day that Louisiana’s state sales tax finally regained some semblance of fiscal sanity.

After a year of paying sky-high taxes, Louisiana families were in line for much-needed relief when sales tax dropped from 5 percent to 4 percent.

Instead, they’ll be paying a rate of 4.45 percent.

The reason for the ludicrous tax burden isn’t difficult to decipher if you read recent news reports about an audit by the nonpartisan Louisiana Legislative Auditor’s Office. That report uncovered the truth behind Gov. Edwards’ threats to yank TOPS from your kids, evict your grandmother from the nursing home and close your community hospital.

The state isn’t strapped for cash because you need to pay even more in taxes. The state is strapped for cash because it can’t competently manage a program that consumes nearly half the state budget.

That’s what the Louisiana Legislative Auditor’s Office discovered when it peeked behind the curtain at the state Department of Health and Hospitals’ Medicaid program books. Auditors looked for errors in DHH’s paperwork for management of the Medicaid program. The results were far from pretty.

The scathing audit found that DHH has been downright sloppy in managing billions of dollars. Auditors couldn’t determine if taxpayer dollars were spent properly. In other words, we have no idea whether DHH has allowed billions of dollars to fly out the window.

The sloppiness occurred even though Medicaid is a monster of a program that consumes 40 percent of the state budget. The sloppiness occurred even though a whopping 24.3 percent of Louisiana’s revenue dollars went to Medicaid in 2016, according to the Pew Charitable Trusts. The sloppiness occurred even though the state supposedly is so strapped for cash that it has to let out prisoners and increase taxes in order to pay for TOPS, roads and other expenses. Sadly for Louisiana families, the reason for the tax increase is that DHH can’t master simple management skills.

Louisiana hired private companies – called managed care organizations – to oversee health services for 1.5 million Medicaid patients a few years ago. The state is supposed to look over the MCOs’ shoulder to ensure that taxpayers’ hard-earned money is being spent wisely. Instead, DHH took a nap and didn’t verify spending by health care providers to the tune of billions of dollars.

The Legislative Auditor’s Office summed it up this way: “Without reliable provider data, (DHH) cannot effectively monitor the MCOs and decrease the risk of improper payments in the Medicaid program.”

Here’s one example of the sloppy work by DHH: The audit uncovered $2.4 billion in claims that lacked basic identification numbers. That meant DHH couldn’t determine if the billed medical service was even legitimate. How do we know that a hospital worker didn’t hit the wrong computer key and accidentally send in a bill for open heart surgery instead of a broken arm patchup?

This wasn’t a quick look at the paperwork either. Auditors pored over five years’ worth of records.

It’s important to check, double check and triple check billing records because taxpayers across the U.S. lose billions of dollars each year to payments that were improperly made by government agencies.

Nationally, federal agencies made $141 billion in improper payments in federal fiscal year 2017. More than 60 percent of those improper payments were in the Medicare and Medicaid programs. Sometimes, people scheme to illegally take money from taxpayers. Lots of people go to jail every year for Medicaid fraud. Other times, government is sloppy and approves payment on hospital bills that patients should pay.

When the payments are due to fraud, we need to prosecute someone. When the payments are due to incompetence, we need to fire someone.

What’s going on at DHH is absolute incompetence.

Taxpayers sacrifice billions of dollars every year to provide health care through the Medicaid program.

DHH is poorly managing those dollars. Is it any wonder why Gov. Edwards keeps claiming he needs to increase your taxes?

U.S. Sen. John Kennedy is a Louisiana Republican.

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